Research Progress on Polysaccharide-Based Drugs in the Treatment of Diabetic Nephropathy

Abstract

Diabetic nephropathy (DN) is one of the most common microvascular complications of diabetes mellitus, involving multiple complex pathological processes during its initiation and progression, including glucose metabolism disorders, oxidative stress, inflammation, renal interstitial fibrosis, and gut microbiota dysbiosis. Current clinical treatment options are limited and associated with certain adverse effects. As one of the main active components of traditional Chinese medicine, natural polysaccharides exhibit characteristics such as multi-target action and low toxicity, demonstrating substantial potential in the prevention and treatment of diabetic nephropathy. This article systematically reviews the current research status of polysaccharide-based drugs in DN treatment, exploring their mechanisms of action from the perspectives of improving insulin resistance, inhibiting oxidative stress, alleviating inflammatory responses, combating renal interstitial fibrosis, and regulating intestinal microecology. It summarizes relevant experimental evidence from plant-derived and fungal-derived polysaccharides, and provides insights into quality control, mechanistic research, and clinical application. Studies have demonstrated that polysaccharides exert multi-target synergistic effects by regulating various signaling pathways, including TGF-β1/Smads, PI3K/Akt, NF-κB/NLRP3, cAMP/PKA/CREB, and PI3K/GSK-3β/Nrf2, thereby offering new strategies and directions for the treatment of diabetic nephropathy.